Minister Harney announces Government decision to prepare legislation for licensing of hospitals and healthcare providers
Implementation of key recommendation of Report of the Commission on Patient Safety and Quality Assurance
The Minister for Health & Children, Ms. Mary Harney T.D., today (12th February 2009) announced key steps to implement the Report of the Commission on Patient Safety and Quality Assurance, principally, the Government’s decision to prepare legislation for the licensing of healthcare providers.
The Minister for Health and Children established the Commission on Patient Safety and Quality Assurance in January 2007 to develop clear and practical recommendations to ensure the safety of patients and the delivery of high quality health and personal social services. The Commission reported in July 2008. The report was published in August 2008 and was brought to Government by the Minister recently.
The Report sets out a comprehensive policy framework to ensure Patient Safety and Quality in our health service.
The Minister said “The Government place great importance on the policies and practical reforms we are implementing to ensure patient safety and quality-assured health services. In the Programme for Government, we undertook to bring forward and implement recommendations of the Commission on Patient Safety and Quality Assurance.
“I am pleased to announce today that the Government, having considered the Report of the Commission on Patient Safety and Quality Assurance, have decided to draw up legislation to give effect to its central recommendation on the licensing of both public and private healthcare providers.
“The licensing system will establish objective, mandatory standards and compliance with standards will be legally required for every hospital or healthcare provider. The legislation will be complex, and it is important that we start out on the legislative path now.
“In fact, in relation to long term care and nursing homes, we are already a very long way down this legislative road, where this year, we will go live with our new system of mandatory standards, inspections and licensing for both public and private providers.
“As we prepare more legislation, patient safety and quality-assurance will continue to drive our current reforms in cancer care and the re-organisation of services, for example, in the Mid-Western region.
“The Government also strongly support improved governance in our hospitals, and in particular, the introduction of systematic audit of clinical practice and outcomes for patients. Had such a system been in place, practices which have had catastrophic effects for patients, for example, the pattern of interventions by Dr Neary at Our Lady of Lourdes Hospital in Drogheda in the 1990s, would have been picked up and stopped earlier.
“The Government have also supported the immediate establishment of a Steering Group to drive implementation of the Report’s recommendations.
“The safety of patients must always be at the heart of what we do. I strongly encourage health service managers and the leaders of the medical, nursing and other professions to take on leadership roles to achieve real and lasting improvements in safety and quality care.
“We are already seeing how much can be achieved with clinical leadership in many areas of reform, in cancer care, in the Mid West, in Kilkenny, in services for older people, in fact, in many areas of our health services where the improvements for patients are visible locally, but don’t receive national prominence.
“I also encourage patients and patients’ advocates to play an active and constructive part in embedding safe care in our systems, on the basis of evidence and experience.
“The Commission has underlined that the culture of patient safety requires openness, transparency, facing facts and a blame free culture. Accordingly, on 30 January last, I signed into law the commencement of the protected disclosures provisions of the Health Act 2007. This will facilitate all healthcare staff making such disclosures in an environment where they are protected from penalisation in the workplace and from civil liability and will come into effect from the 1st of March next.
“I am very pleased also that, within my Department, the Office of the Chief Medical Officer has now been assigned executive responsibility for all matters relating to Patient Safety. This includes the new protocol introduced last year for dealing with all communications to the Department about significant patient safety issues. It is critical that a considered clinical view is taken, and advice given, to the Minister about the significance of issues that arise or are raised from a patient safety perspective.
“All of these measures are paving the way for the new culture of patient safety, openness, transparency, learning and accountability which is envisaged by the Commission and form an excellent framework for the implementation of this Report. The Commission’s work will improve health services for many years and I want to thank again its Chairperson, Dr Deirdre Madden and all its members for their tremendous input.
“Putting patient and patient safety first ultimately leads us all to embrace change where the best interests of patients demand it.”
In regard to licensing of healthcare providers, the Commission recommended that both public and private providers should be covered and licensing should commence with acute hospitals.
It recommended a health service-wide system of governance based on corporate accountability for the implementation of nationally agreed managerial and clinical standards.
Its recommendations also include a mandatory system of adverse event reporting, legal protection/privilege for open disclosure which is undertaken in good faith, exemption from FOI legislation and legal discovery of data collected solely for the purposes of improving safety and quality of healthcare.
The Minister recognises that it will require time and resources to implement the full range of actions in this agenda for change. It will pose considerable challenges to service providers in both the public and private sectors and to all those organisations and people involved in the regulation and development of the service.
The system of licensing will be self-financing. This will involve all service providers paying licence fees that will cover the cost of the administration and inspection regime which such a system will necessitate. The Government is adopting a similar approach to other areas of this nature. The Health Information and Quality Authority will commence nursing home registration and inspections later this year. This will involve substantial costs on the Exchequer and it is only right that these costs should be met by the service providers. Accordingly, the Minister has decided that the fees to be charged to such providers, including those operating in both the public and private sectors, by HIQA should be largely on a self-funding basis. Such fees are provided for in the Health Act 2007 and will be the subject of regulations to be made in the very near future.
An Implementation Steering Group, chaired by the Department’s Chief Medical officer, Dr Tony Holohan, will be established to oversee the implementation of the Commission’s recommendations while the Department of Health and Children will progress the necessary legislation. The Minister will instruct the Implementation Steering Group to develop and submit implementation costings and proposals for how and over what timescale these could be funded by better use and reallocation of existing resources.
- The Commission on Patient Safety and Quality Assurance was established by Mary Harney, TD, Minister for Health and Children in January 2007.
- The Commission was chaired by Dr. Deirdre Madden, Senior Lecturer, Faculty of Law, University College Cork and included members from the HSE, Health Information and Quality Authority, medical consultants, general practice, pharmacy, nursing, patients and the Department of Health and Children.
- The Commission reported to the Minister in July 2008.
- More details on the work of the Commission and a copy of its report are available at www.cpsqa.ie